국내 알레르기 유발식품 표시제의 현황과 문제점

전유훈,김현희,박용민,장광천,김혜영,염혜영,김지현,안강모,민택기,편복양,이수영,김경원,김윤희,이정민,이소연,김우경,송태원,김정희,이용주,대한 소아알레르기 호흡기학회 식품알레르기 아토피피부염 연구회 대한 소아알레르기 호흡기학회 2019 Allergy Asthma & Respiratory Disease Vol.7 No.2

With increasing need to prevent serious food allergy reactions, Korean food allergen labeling regulation has been revised repeatedly. This paper aims to summarize current statuses of food allergen labeling in Korea and foreign countries and to analyze the issue of food allergen labeling regulation. Korean food labeling regulation currently requires 19 items and 22 foods to be reported on labels (eggs, milk, buckwheat, peanut, soybean, wheat, mackerel, crab, shrimp, pork, peach, tomato, sulfite, walnut, chicken, beef, squid, shellfish, and pine nut). However, some common food triggers (for example, almond, cashew nut, and kiwi fruit) are not included in the current labeling regulation. Another issue is that the Korean labeling regulation has not yet been fully implemented for nonprepacked foods; thus, consumers still have difficulty in correctly identifying allergenic ingredients in food. It should be assessed whether warning statements for cross-contamination are reasonable. To prevent the occurrence of serious reactions from accidental ingestion, efforts must be made to solve recently raised issues including the items required to be listed on food labels, the system of standards for labeling and display methods.

Effects of Vacuuming Mattresses on Allergic Rhinitis Symptoms in Children

전유훈,이용주,손명현,이혜란 대한천식알레르기학회 2019 Allergy, Asthma & Immunology Research Vol.11 No.5

Purpose: To evaluate the effects of daily vacuuming of mattresses on the concentration of house dust mite (HDM) allergens and on allergic rhinitis (AR) symptoms in children sensitized to HDM. Methods: Forty children between the ages of 6 and 12 years with mild persistent AR and sensitized only to HDM were enrolled and randomly allocated to 2 groups. Caregivers of children in the experimental group cleaned the children's rooms and vacuumed their mattresses daily for 2 weeks. Caregivers of children in the control group cleaned the children's rooms without vacuuming mattresses. Symptoms of AR were checked weekly and dust samples were collected from the mattresses before and after the study. Results: Demographics at the beginning of the study were not significantly different between the 2 groups. In the experimental group, symptoms of AR and dust weight were significantly decreased after 2 weeks (total symptoms of AR, P <0.001; sneezing, P < 0.001; rhinorrhea, P <0.001; nasal obstruction, P < 0.001; itching, P <0.001; and dust weight, P = 0.006). The concentrations of HDM allergens were not changed significantly (Der p1, P = 0.333; Der f1, P = 0.841). In the control group, there were no significant changes in symptoms of AR, dust weight, or the concentration of HDM allergens. Conclusions: Our findings showed that daily vacuuming of mattresses reduced dust weight and symptoms of AR. However, the concentration of HDM allergens did not significantly decrease.

Infantile Anaphylaxis in Korea: a Multicenter Retrospective Case Study

전유훈,이수영,안강모,이소연,김경원,김현희,김정희,염혜영,김우경,박영민,송태원,김지현,이용주,장광천,정경욱,김윤희,민택기,편복양 대한의학회 2019 Journal of Korean medical science Vol.34 No.13

Background: Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers. Methods: The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea. Results: We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kUA/L for those under the age of 1 and 15 kUA/L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kUA/L for those under the age of 2 and 7 kUA/L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector. Conclusion: Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity.Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.

영아기 아토피피부염 환자의 천명발생 위험인자에 대한 연구

전유훈,양현종,편복양 대한 소아알레르기 호흡기학회 2007 Allergy Asthma & Respiratory Disease Vol.17 No.2

대 상 : 2002년 1월부터 2005년 12월까지 순천향대학교병원 소아 알레르기 호흡기 센터를 방문하여 아토피피부염으로 진단받은 1세 미만의 환자 중 2006년 7월까지 추적관찰이 가능했던 347명을 대상으로 하였다. 방 법 : 대상 환자들의 첫 내원시 천식의 가족력을 조사했으며 원인 항원 특이 IgE치, 총 IgE치의 정량검사, 말초혈액 총 호산구수를 측정하였다. 추적관찰 시점까지 3회 이상의 천명을 보인 군과 3회 미만의 천명을 보였던 군으로 나누고 반복적인 천명과 3세 이상까지 지속되는 천명의 위험요인을 분석하였다. 결 과 : 영아기 아토피피부염 환자에서 천명의 발생은 55.9%로 나타났으며 성별(남아) (aOR 1.7, 95% CI 1.1-2.7, P=0.024)과 천식 가족력(aOR 4.7, 95% CI 1.7-12.5, P=0.002)이 천명의 유의한 위험인자였다. 식품항원 감작(OR 1.0, 95% CI 0.7-1.6, P=0.958), 집먼지진드기 감작(OR 0.8, 95% CI 0.2-3.9, P=0.769), 총 IgE치의 증가(OR 0.9, 95% CI 0.6-1.5, P=0.789), 호산구증가증(OR 1.4, 95% CI 0.9-2.1, P=0.1) 등은 천명의 위험인자로서 통계학적으로 유의한 수치를 보이지 않았다. 총 IgE치의 증가(aOR 5.1, 95% CI 1.1-22.5, P=0.014)와 집먼지진드기 감작(aOR 9.0, 95% CI 0.9-89.4, P=0.087)은 3세 이상까지 지속되는 천명의 위험인자였다. 결 론 : 영아기 아토피피부염 환자 중에서 남아이거나 천식의 가족력이 있는 경우는 반복적인 천명의 위험인자로 생각되며 천식의 발생에 대해 주시할 필요가 있겠다. 또한 영아기에 총 IgE치가 증가했던 경우나 집먼지진드기에 감작이 있는 경우는 지속되는 천식의 위험인자로서 천식의 예방과 조기치료의 대상으로 고려해 볼 수 있겠다. Purpose : Infantile atopic dermatitis (AD) is one of the most important risk factors for development of childhood asthma. Those with persistent wheezing with atopy had a great risk of declining lung function. Our study was designed to find out the risk factors for wheezing in infants who has AD, therefore early detection of risk factors for developing wheezing. Methods : Three hundreds forty seven infants with AD who visited on our Pediatric Allergy Respiratory Center in Soonchunhyang University Hospital from January 2002 to December 2005 were enrolled and they were followed up till July 2006. We obtained familial allergy history and laboratory data such as serum total IgE, specific IgE and blood eosinophil count. We analyzed the factors affecting recurrent wheezing and persistent wheezing after 3 years old in children who had AD during infancy. Results : One-hundred ninety-four children (55.9%) developed wheezing. Male sex (adjusted odds ratio (aOR) 1.7, 95% CI 1.1-2.7) and asthma history of parents or siblings (aOR 4.7, 95% CI 1.7-12.5) were the significant risk factors for development of wheezing. Serum total IgE (aOR 5.1 95% CI 1.1-22.5) and house dust mite sensitization (aOR 9.0, 95% CI 0.9-89.4) were significant risk factors for persistent wheezing after first three years of life. Conclusion : We should be alert for asthma in cases of infantile AD especially in male sex or with familial asthma history. And we propose early identification and intervention for asthma in infantile AD with increased total IgE and with house dust mite sensitization.

Identification of major rice allergen and their clinical significance in children

전유훈,오세조,양현종,이수영,편복양 대한소아청소년과학회 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.10

Purpose: Recently, an increase in the number of patients sensitized to rice allergen with or without clinical symptoms has been reported. This study was designed to determine the major allergens in rice and their clinical significance. Methods: Twenty-four children (15 boys and 9 girls; mean age, 16.3months) with allergic disease, who were sensitized to rice antigen (by UniCAP) in the Pediatric Allergy Respiratory Center at Soonchunhyang University Hospital, were enrolled in this study. The allergenicity of various types of rice (raw, cooked, and heat-treated, simulated gastric fluid [SGF], and simulated intestinal fluid [SIF]) was investigated using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)and immunoglobulin E (IgE) immunoblots. The patients’ medical records,including laboratory data and allergy symptoms after ingestion of rice were reviewed. Results: Patients were sensitized to an average of 13.5 food antigens and their mean total IgE was 6,888.7 kU/L. In SDS-PAGE, more than 16 protein bands were observed in the raw rice, whereas only 14-16kDa and 31-35 kDa protein bands were observed in cooked rice. The common SDS-PAGE protein bands observed in SGF-, SIF-, and heattreated rice were 9, 14, and 31 kDa. In a heated-rice IgE immunoblot,protein bands of 9, 14, and 31-33 kDa were found in 27.8%, 38.9%, and 38.9% of all sera, respectively, and in 50%, 50%, and 75%, of ser a from the 4 symptomatic patients, respectively. Conclusion: The 9-, 14-, and 31-kDa protein bands appeared to be the major allergens responsible for rice allergy symptoms.

소아 천식환아에서 흡입용 fluticasone 및 tulobuterol의 병합치료와 두 배 용량 흡입용 fluticasone 치료의 효과 및 안전성 비교에 대한 다기관 연구

전유훈,양현종,유영,김영호,정지태,이혜란,편복양 대한 소아알레르기 호흡기학회 2009 Allergy Asthma & Respiratory Disease Vol.19 No.2

목 적 : 소아 천식 치료에서 흡입용 스테로이드의 용량을 증가시키는 것과 기존 용량의 흡입용 스테로이드에 기관지 확장제인 tulobuterol을 추가하는 것을 효과와 안전성 면에서 비교해 보고자 하였다. 방 법 : GINA 가이드라인에 따라 2단계(경증 지속성) 천식으로 진단받고 하루 50-100 µg의 저용량 흡입용 스테로이드(fluticasone)로 유지치료를 받고 있는 4-8세의 소아천식 환자 중에서 step-up 치료를 고려하는 53명을 대상으로 하였다. 이들을 무작위로 기존의 흡입용 fluticasone 용량(50-100 µg/일)에 tulobuterol (Hokunalin® patch 1 mg)을 추가한 군 (Flt+Hk군)과 흡입용 fluticasone을 두 배 용량(100-200 µg/일)으로 늘린 군 (Flt군)으로 나누었다. 이들을 각각 4주간 치료하였으며 이후 치료의 효과와 부작용을 보기 위해 추적관찰하였다. 두 군에서 치료시작전과 치료 4주 후의 천식 증상 점수의 변화, 일중 최대호기유속의 변화, 야간 증상으로 잠을 깬 횟수, 증상완화제의 사용 횟수를 비교하였고 치료에 대한 보호자의 전체적인 만족도, 이상 반응의 횟수를 조사하였다. 결 과 : 추적관찰이 된 환자는 Flt+Hk 군, Flt 군 각각 24명이었다. 치료시작전과 치료 4주 후 두 군간의 전체적인 천식증상점수 변화는 Flt+Hk 군에서 -0.01±0.24 , Flt 군에서 -0.05±0.17로 두 군 간에 통계적으로 유의한 차이는 없었다.(P= 0.54) 아침 최대호기유속의 평균변화와 저녁 최대호기유속의 평균 변화는 통계적으로 큰 차이를 보이지 않았다.(P=0.83, P=0.83) 야간 증상으로 잠을 깬 횟수나 증상완화제의 사용 횟수, 치료에 대한 보호자의 전체적인 만족도도 두 군 간에 차이가 없었다.(P=0.17, P=0.32, P=0.63) 치료 중의 이상 증상의 경험 빈도 역시 통계학적으로 유의한 차이를 보이지 않았다.(P=1.00) 결 론 : 소아천식환아에서 흡입용 fluticasone propionate및 tulobuterol의 병합치료는 두 배 용량의 흡입용 fluticasone propionate 단독치료만큼 효과가 있으며 안전성도 비슷한 것으로 나타났다. 스테로이드 치료에 대한 거부감이나 잠재적 부작용에 대한 두려움을 가지고 있는 환자에서 흡입용 스테로이드의 용량을 늘리는 치료에 대한 대체치료로 tulobuterol의 병합치료를 고려할 수 있겠다. Purpose : We aim to compare the effectiveness and safety of fluticasone propionate (Flt) plus tulobuterol (Hk) versus high-dose Flt alone in controlling asthma in children. Methods : Fifty three children aged 4 to 8 years, who were diagnosed with mild persistent asthma and underwent maintenance therapy with a low dose of inhaled corticosteroid (Flt) of 50-100 µg/day were randomized to receive Flt plus Hk (Hokunalin® patch 1 mg, Abbott Japan, Tokyo, Japan), or Flt alone at twice the dosage. Patients underwent new treatment for 4 weeks. Asthma symptom scores, mean changes in morning and evening peak expiratory flow (PEF), the frequency of night awakenings, the use of reliever medication, caregiver's overall satisfaction and safety were evaluated and compared in each group. And they were followed-up again 4 week after treatment course for the evaluation of treatment- emergent adverse event (TEAE). Results : No significant difference was found between the groups in terms of mean changes in the morning and evening PEF, the frequency of night awakening, the use of rescue medication and caregiver's overall satisfaction (P=0.83, P=0.83, P=0.17, P=0.32 and P=0.63). Furthermore, no statistically significant difference was observed between 2 groups in the incidence of any TEAE (P=1.00). Conclusion : This study demonstrated that a combination of Flt and Hk was as effective as a high-dose Flt therapy in the management of mild persistent asthma in children. The results of this study suggest that tulobuterol add-on therapy can be considered as a reasonable substitute to an increase in the dosage of steroid in the patients with steroid-phobia and it might be used to reduce the risk of high dose steroid therapy.

Lung Function in Korean Adolescent Girls: in Association with Obesity and the Menstrual Cycle

전유훈,양현종,편복양 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Gender differences in asthma have been observed with a preponderance of boys affected before puberty and girls during and after puberty. The known influences of the menstrual cycle on asthma support a role for female sex hormones on the changing expression of asthma during adolescence. The purpose of this study was to investigate obesity, the menstrual cycle and lung function in adolescent girls. One hundred and three female high school girls (mean age: 15.9±0.8 yr) were enrolled. The investigation was performed using a questionnaire that included history of asthma, the menstrual cycle, other combined allergic disease and obesity. The skin prick and pulmonary function test during menstruation period and non-menstruation period. Analyses of these factors were compared. The forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was significantly lower in the obese group compared to the non-obese group (99.8±13.8 vs. 107.1±10.2, p=0.03). The FEV1 was significantly lower in the girls during menstruation period than in the girls who were not on menstruation (77.5±10.2 vs. 80.4±8.6, p=0.03). Our results showed that changes of pulmonary function were related to menstrual cycle and obesity in Korean adolescent girls.

Clinical improvement in a case of atypical infantile onset Pompe disease with enzyme replacement therapy

전유훈,은백린,손창성,이동환 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.2

Pompe 병(Glycogen storage disease type Ⅱ)은 acid α- glucosidase (GAA)의 결손에 의한 질환이며 열성으로 유전한다. 전신적인 근육약화와 비후성 심근병이 생긴 후 대개 1년 안에 사망하게 되는 영아기 발병형과 상대적으로 임상양상이 경한 후기 발병형이 있다. Pompe 병의 국내 보고는 드문 상태이나 최근 GAA 효소 보충 요법이 개발되어 임상적으로 시도 중이다. 저자들은 발병은 영아기에 있으나 비교적 임상증상이 심하지 않은 비전형적 영아형 Pompe 병을 진단받고 심한 간비대와 비후성 심근병증, 보행곤란의 증상을 보이던 4세 남아에게 재조합 인간 GAA 효소(Myozyme , Genzyme Co., MA, USA) 치료를 하여 운동능력과 심기능의 현저한 호전을 경험하였기에 보고한다. 비전형적 영아형 Pompe 병에서는 ERT의 효과가 더욱 큰 것으로 생각되며 소아과의사들이 비전형적 Pompe 병 초기의 특징인 비음이나 동요성 보행같은 증상을 이해하고 있어 이를 빨리 진단하고 효소보충요법을 조기에 시행한다면 Pompe 병 환아의 예후를 호전시킬 수 있겠다. Pompe disease is a genetic disorder caused by a deficiency of acid α-glucosidase (GAA). Infantile onset Pompe disease is uniformly lethal. Affected infants generally present in the first few months of life with hypotonia, generalized muscle weakness, and a hypertrophic cardiomyopathy, which is rapidly followed by death, usually by the age of one. The late-onset form is characterized less severe symptoms and prognosis. Therapy for Pompe disease is intended to directly address the underlying metabolic defect via intravenous infusions of recombinant human GAA to replace the missing enzyme. We report a case of atypical infantile-onset Pompe disease that presented symptoms in infancy but had less severe clinical manifestations and improved after GAA enzyme replacement (Myozyme , Genzyme Co., MA, USA) therapy. It is very important that pediatricians become aware of signs and symptoms of Pompe disease, such as a nasal voice or a waddling gait at an early stage so that these patients can benefit from appropriate GAA replacement therapy as soon as possible.

A Double-Blind, Randomized, Crossover Study to Compare the Effectiveness of Montelukast on Atopic Dermatitis in Korean Children

전유훈,민택기,양현종,편복양 대한천식알레르기학회 2016 Allergy, Asthma & Immunology Research Vol.8 No.4

Purpose: Some studies report a role of leukotrienes in the pathogenesis of atopic dermatitis and suggest a rationale for the use of leukotriene receptor antagonist (LTRA) in the treatment of atopic dermatitis. This study aimed to evaluate the treatment effectiveness of montelukast in children with atopic dermatitis. Methods: Fifty-four children between the ages of 2 and 6 years with moderate to severe atopic dermatitis were enrolled. Group A received montelukast for 8 weeks, followed by a crossover to 8 weeks of placebo after a 2-week washout period. Group B reversed the administration according to a randomized, double-blind, placebo-controlled, crossover design. The SCORing atopic dermatitis (SCORAD) index, urinary leukotriene E4 (LTE4), and eosinophil-derived neurotoxin (EDN) were assessed at every visit. Results: Forty-three patients (21 males) completed the study. Although the SCORAD index was decreased in both groups, there was no statistically significant difference between montelukast and placebo (-3.0±11.2 vs -5.7±11.3, P=0.43). The level of urinary LTE4 was decreased after taking montelukast when compared to placebo, but there was no statistically significant difference (-65.9±556.2 vs 87.7±618.3, P=0.26). The changes in urinary EDN after taking montelukast and placebo had no significant difference (37.0±1,008.6 vs -195.8±916.7, P=0.10). When analyzing SCORAD indices, urinary LTE4, and EDN, we could not prove the effectiveness of montelukast in the atopic, non-atopic or high ECP (ECP ≥15 μg/L) subgroups. Conclusions: There was no statistically significant difference in clinical improvement or biomarkers between montelukast and placebo treatment. Therefore, conventional treatments with skin care and infection control might be more important strategies in the treatment of atopic dermatitis.

효소 보충 치료로 호전을 보인 Pompe병 1례

전유훈,은백린,이동환,Jeon, You Hoon,Eun, Baik Lin,Lee, Dong Hwan 대한유전성대사질환학회 2005 대한유전성대사질환학회지 Vol.5 No.1

저자들은 Pompe 병으로 진단된 3세 남아에 recombinant human GAA 정주를 통한 효소 보충 치료를 시행하여 운동 능력과 심기능이 호전되며 간비대도 호전된 1례를 경험하였기에 보고하는 바이다. Pompe disease is a genetic disorder caused by a deficiency of acid ${\alpha}$-glucosidase (GAA). This enzyme defect results in lysosomal glycogen accumulation in multiple tissues and cell types, with cardiac, skeletal, and smooth muscle cells the most seriously affected. Infantile-onset Pompe disease is uniformly lethal. Affected infants present in the first few months of life with hypotonia, generalized muscle weakness, and a hypertrophic cardiomyopathy, followed by death from cardiorespiratory failure or respiratory infection, usually by 1 year of age. Late-onset forms is characterized by a lack of severe cardiac involvement and a less severe short-term prognosis. Enzyme replacement therapy for Pompe disease is intended to address directly the underlying metabolic defect via intravenous infusions of recombinant human GAA to provide the missing enzyme. We experienced one case of Pompe disease in 3-years old boy that has improved his exercise ability and cardiac function after GAA enzyme replacement therapy.